Skin Cancer: What You Need to Know

Skin Cancer:
What You Need to Know
You Can Protect Yourself Against Skin Cancer!
Table of Contents
3–4
Types of Skin Cancer
Our skin is actually the largest organ of the human body and the health
and appearance of our skin often has a profound impact on our quality of
life. It plays an extremely important role in protecting our entire body from
5–6Risk Factors for
Skin Cancer
harmful bacteria, water loss, and serves as a buffer between the outside
7–13
Melanoma Skin Cancers
control body temperature, protects the rest of the body from ultraviolet
—Signs and Symptoms
(UV) light, and helps the body make Vitamin D. It also plays a key role
—Identifying Moles
—Ultraviolet Radiation
in creating and maintaining our individual identity, as this protective
—Staging Melanoma
—Treatment Options
14–15
Prevention and Early
Diagnosis
16–17Teen Tanners
18Questions to Ask
Your Doctor
19Contact Information
world and our inner organs, including muscle, bones, etc. Skin also helps
covering helps create the ‘picture’ of what we see when we look in a mirror.
Human beings have long been concerned with their appearance, and
therefore have taken an interest in “skin” appearance since the dawn of
mankind.
As the largest—and often the most exposed—organ of the body, it should
not be surprising that skin cancers are far and above the most common
cancer that occurs in humans. Fortunately, the vast majority of these
cancers are very treatable, and with timely care, they do little to interfere
with our daily lives. The two most common types of skin cancers (Basal
Cell and Squamous Cell) occur so often, that they are not even tracked by
our national or global Tumor Registries. These are sometimes referred to
as non-melanoma skin cancers (NMSC). The American Cancer Society
(ASC) estimates that 3.5 million cases of NMSC were diagnosed in 2012
in the United States alone. Most NMSCs are highly curable with timely
Skin cancers are far and
above the most common
cancer that occurs in
humans.
treatment; however, identifying the problem, seeking treatment, and
obtaining timely treatment can still be a challenge for many people. In
2012, more than 75,000 Americans were diagnosed with melanoma,
the most serious skin cancer. Most significant is the fact that melanoma
incidence rates have been increasing by almost three percent per year in
both men and women, according to the National Cancer Institute (NCI)
and the ACS. The trauma and losses from delays in treating even the
most common skin cancers are very significant. As with all cancers, early
diagnosis and timely intervention is vital to good health and even survival.
The focus of this report will be on the most serious of skin cancers:
melanoma. However, references will be provided for further information
on the NMSCs, as they too demand timely attention.
2
What is Skin Cancer?
There are three main types of
Skin cancer develops when skin cells start to grow in an abnormal way. It
most often begins on areas of your skin that have had significant exposure
to sunlight, but it can also occur in skin cells that would not normally be
exposed to sun. Like other cancers, if left alone, the abnormal cells will
continue to grow and eventually will push their way into healthy tissues,
causing many different types of problems, depending on the type of cancer,
the growth rate, and the location. That is why our focus for all skin
cancers is (1) Prevention and (2) Early Diagnosis and Treatment.
skin cancer:
Types of Skin Cancer
• Basal cell carcinoma
• Squamous cell carcinoma
• Malignant melanoma
All of these cancers need early
identification and intervention/
treatment to minimize the
damage to surrounding healthy
There are three main types of skin cancer: basal cell carcinoma,
squamous cell carcinoma, and malignant melanoma. Basal cell and
Squamous cell are far more common than melanoma, and fall into the
category of NMSC (Non-melanoma skin cancer). However, all of these
cancers need early identification and intervention/treatment to minimize
the damage to the healthy cells around the abnormal cancer cells.
cells.
Melanoma incidence rates have been increasing by almost three
percent per year in both men and women (NCI, ACS).
Human Skin Layers
Epidermis—Top layer of skin. Made up of squamous cells
Melanocyte
Melanin
Squamous cell skin cancers start here
Basal Cells—line the basement membrane which
protects dermis and blood vessels
Basal cell skin cancers start here
Melanocytes—exist in base of epidermis. Make brown
pigment (melanin) which gives skin its color. Helps protect
deep skin layers from sun (UV radiation)
Malignant melanoma skin cancers start here
ARTWORK WIKIMEDIA COMMONS
3
What Does Skin Cancer Look Like?
The signs and symptoms,
Basal Cell Carcinoma
as well as the treatment
Basal cell carcinoma usually presents as a
raised, smooth, pearly bump on the sunexposed skin of the head, neck or shoulders.
Sometimes small blood vessels can be seen
within the tumor. Crusting and bleeding in the
center of the tumor frequently develops. It is
often mistaken for a sore that does not heal. This
form of skin cancer is the least deadly and with
proper treatment can be completely eliminated,
often without scarring.
and prognosis, are based
upon the type of skin cell
the cancer originated in,
and how far and fast it has
grown. The information here
shows examples of three
different types of cancerous
skin lesions.
James Heilman, M.D., photo
Squamous Cell Carcinoma
Often a very rapid growing tumor, squamous
cell carcinoma (SCC) is commonly a red,
scaling, thickened patch on sun-exposed
skin. Some are firm hard nodules and dome
shaped. Ulceration and bleeding may occur.
When SCC is not treated, it may develop into
a large mass. Squamous cell is the second
most common skin cancer. It is dangerous, but not nearly as dangerous as a
melanoma.
Malignant Melanoma
The common appearance is an asymmetrical
area, with an irregular border, color variation,
and often greater than 6 mm diameter (pencil
eraser). Most melanomas are brown to black
looking lesions; a few melanomas are pink, red
or fleshy in color which are called amelanotic
melanomas. Unfortunately, these tend to be
more aggressive. Warning signs of malignant melanoma include change in
the size, shape, color or elevation of a mole. Other signs are the appearance
of a new mole during adulthood or new pain, itching, ulceration or bleeding
of a mole.
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PHOTOGRAPHS WIKIMEDIA COMMONS
Who Gets Skin Cancer?
Nearly everyone on earth, if they live long enough, will develop some sort
of skin cancer. There are, however, different levels of risk, depending on
each person’s exposure to known “risk factors” for skin cancer. A risk factor
is anything that affects your chance of developing a problem or disease.
Having a known risk factor does not mean you will definitely develop a
disease. Also, not having any known risk factors does not mean you will
never develop a specific disease. Rather, knowledge about risk factors allows
you to evaluate your own personal risk (chance) of developing that disease,
and should also teach you how you can minimize your individual risk for
any specific disease.
Ultraviolet radiation is
divided into three wave
length ranges:
Risk Factors for Skin Cancer
UVB rays can cause direct
damage to the DNA, and
are the main rays that cause
sunburns. They are also thought
to cause most skin cancers.
#1 Ultraviolet (UV) radiation exposure. Ultraviolet (UV) radiation is a
major risk factor for nearly all skin cancers. UV radiation damages the DNA
of skin cells. Skin cancers begin when this damage affects the DNA of genes
that control skin cell growth. Sunlight is the main source of UV radiation,
which can damage the genes in your skin cells. Tanning lamps and beds are
also sources of UV radiation. A tan is your skin’s injury response to excessive
UV radiation. In 2012, California became the first state to ban the use of
UV indoor tanning beds for all minors under age 18. People with high levels
of exposure to light from these sources are at greater risk for skin cancer,
including malignant melanoma.
Additional Risk Factors for Developing Skin Cancer
Sources: (Mayo Clinic 2012; Skin Cancer Foundation 2012 )
Fair skin. Anyone, regardless of skin color, can get skin cancer. However,
having less pigment (melanin) in your skin provides less protection from
damaging UV radiation. If you have blond or red hair and light-colored eyes,
and you freckle or sunburn easily, you’re much more likely to develop skin
cancer than is a person with darker skin.
A history of sunburns. Having had one or more blistering sunburns as a
child or teenager increases your risk of developing skin cancer as an adult.
Sunburns in adulthood also are a risk factor.
Sunny or high-altitude climates. People who live in sunny, warm climates
(closer to the equator) are exposed to more sunlight than are people who
live in colder climates. Living at higher elevations, where the sunlight is
strongest, also exposes you to more radiation.
UVA rays cause cells to age
and can cause some damage to
cells’ DNA. They are linked to
long-term skin damage such as
wrinkles, but are also thought
to play a role in some skin
cancers.
UVC rays don’t get through our
atmosphere and therefore are
not present in sunlight. They
are not normally a cause of skin
cancer.
While UVA and UVB rays make
up only a very small portion of
the sun’s wavelengths, they are
the main cause of the damaging
effects of the sun on the skin.
Both UVA and UVB rays
damage skin and cause skin
cancer. UVB rays are a more
potent cause of at least some
skin cancers, but based on
what is known today, there are
NO safe UV rays.
The amount of UV exposure
depends on the strength of the
rays, the length of time the skin
is exposed, and whether the
skin is protected with clothing
or sunscreen.
5
Additional Risk Factors for Developing Skin Cancer, continued
Occupations/lifestyles that increase UV light exposure. People who
spend the majority of the daylight hours outdoors (agriculture, ranching,
forestry, etc.), as well as those who drive for a living.
Moles. People who have many moles or abnormal moles called dysplastic
nevi are at increased risk of skin cancer. These abnormal moles—which look
irregular and are generally larger than normal moles—are more likely than
others to become cancerous. If you have a history of abnormal moles, watch
them regularly for changes.
Precancerous skin lesions. Having skin lesions known as actinic keratoses
can increase your risk of developing skin cancer. These precancerous skin
growths typically appear as rough, scaly patches that range in color from
brown to dark pink. They’re most common on the face, head and hands of
fair-skinned people whose skin has been sun damaged. They are usually
easily removed/treated by your doctor.
A family history of skin cancer. If one of your parents or a sibling has had
skin cancer, you may have an increased risk of the disease.
A personal history of skin cancer. If you developed skin cancer once,
you’re at risk of developing it again. Even basal cell and squamous cell
carcinomas that have been successfully removed can recur.
A weakened immune system. People with weakened immune systems
have a greater risk of developing skin cancer. This includes people living
with HIV/AIDS or leukemia and those taking immunosuppressant drugs
after an organ transplant.
Exposure to radiation. People who received radiation treatment for skin
conditions such as eczema and acne may have an increased risk of skin
cancer, particularly basal cell carcinoma.
Exposure to certain substances. Exposure to certain substances, such as
arsenic, may increase your risk of skin cancer.
Age. Although the risk of nearly all cancers increase with age (more time for
skin damage), malignant melanoma, the most serious form of skin cancer is
one of the most common cancers in people younger than 30. Melanoma that
runs in families may occur at a younger age.
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PHOTO BY CHRIS BURKARD
Melonoma: The most dangerous type of skin cancer
Definition of Melanoma:
Melanoma is a form of cancer that begins in melanocytes (cells that make
the pigment melanin). It may begin in a mole (skin melanoma), but can
also begin in other pigmented (colored) tissues, such as in the eye or in
the intestines. We do not always know exactly what damages the DNA
in skin cells that leads to melanoma. It appears that it is often related to a
combination of things, including environmental and genetic factors. Still,
doctors believe exposure to ultraviolet (UV) radiation from the sun and
from tanning lamps and beds is the leading cause of melanoma.
The risk of melanoma seems to be increasing in people under 40, especially
women. (Mayo Clinic) Knowing the warning signs of skin cancer can help
ensure that cancerous changes are detected and treated before the cancer
has spread. Melanoma can be treated successfully if it is detected early.
Non-Melanoma Skin
Cancers (NMSC)
Due to the fact that nationwide
statistics are not maintained
on non-melanoma skin cancers
(NMSC), the next section of
this summary will focus on
melanoma. However, the last
portion of this report, focusing
on prevention and early
detection, will be applicable to
ALL skin cancers.
Signs and Symptoms
Melanomas can develop anywhere on your body. They most often develop
in areas that have had exposure to the sun, such as your back, legs, arms
and face. Melanomas can also occur in areas that don’t receive much sun
exposure, such as the soles of your feet, palms of your hands and fingernail
beds. These hidden melanomas are more common in people with darker
skin.
The first melanoma signs and symptoms often are:
• A change in an existing mole
• The development of a new pigmented or unusual-looking growth
on your skin
• Melanoma doesn’t always begin as a mole. It can also occur on otherwise
normal-appearing skin.
Estimated new cases and deaths from melanoma in the United States
in 2012 (NCI): New cases: 76,250 • Deaths: 9,180
7
Melanoma, continued
Melanomas can vary greatly
Normal Moles
in how they look. Many show
Normal moles are generally a uniform color, such as tan, brown or black,
with a distinct border separating the mole from your surrounding skin.
They're oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter—the size of a pencil eraser. Most people have between
10 and 45 moles. Many of these develop by age 40, although moles may
change in appearance over time and some may even disappear with age.
all of the ABCDE features.
However, some may show
changes or abnormal areas
in only one or two of the
ABCDE features. In more
advanced melanoma, the
change. The skin on the
Often the first sign of melanoma is a change in the shape, color, size, or feel
of an existing mole. Melanoma may also appear as a new mole. Thinking of
“ABCDE” can help you remember what to look for:
surface may break down
• Asymmetry: The shape of one half does not match the other half.
and look scraped. It may
• Border that is irregular: The edges are often ragged, notched, or blurred
in outline. The pigment may spread into the surrounding skin.
texture of the mole may
become hard or lumpy. The
surface may ooze or bleed.
Sometimes the melanoma
is itchy, tender, or painful.
(Source: NCI)
• Color that is uneven: Shades of black, brown, and tan may be present.
Areas of white, gray, red, pink, or blue may also be seen.
• Diameter: There is a change in size, usually an increase. Melanomas can
be tiny, but most are larger than the size of a pea (larger than 6 millimeters
or about 1/4 inch).
• Evolving: The mole has changed over the past few weeks or months; the
mole is new.
Melanomas
Normal Moles
ABCD rule illustration:
On the left, from top to bottom:
melanomas showing
(A) Asymmetry, (B) a border that
is uneven, ragged, or notched,
(C) coloring of different shades
of brown, black, or tan and
(D) diameter that had changed in
size.
The normal moles on the right
side do not have abnormal
characteristics (no asymmetry,
even border, even color, no
change in diameter).
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PHOTOGRAPHS WIKIMEDIA COMMONS
Incidence (How Often it Occurs)
The incidence of melanoma
Melanoma does not occur as often as the non-melanoma skin cancers (3.5
million/year), but due to the potentially deadly results, it is considered
a serious cancer. Based on rates from 2007-2009, 2 percent of men and
women born today will be diagnosed with melanoma of the skin at some
time during their lifetime. This number can also be expressed as one in
every 50 men and women will be diagnosed with melanoma of the skin
during their lifetime. As noted within risk factors, people with fair skin and
hair have the highest risk of developing melanoma. This is reflected in the
U.S. incidence rates by race in the chart below (Source: NCI). These rates
are based on cases diagnosed in 2005-2009 from 18 SEER geographic
areas (nationwide data).
has been increasing for at least
30 years. Since 2004, the
incidence rates among whites
have been increasing by almost
3 percent per year, for both
men and women (ACS).
Melanoma Incidence Rates by Race in U.S.
Race/EthnicityMale
Female
All races
27.2 per 100,000 men
16.7 per 100,000 women
White
31.6 per 100,000 men
19.9 per 100,000 women
Black 1.1 per 100,000 men 0.9 per 100,000 women
Asian/Pacific Islander 1.6 per 100,000 men 1.2 per 100,000 women
American Indian/
Alaska Native
4.3 per 100,000 men
4.0 per 100,000 women
Hispanic
4.7 per 100,000 men
4.6 per 100,000 women
Diagnosing Melanoma (and other Skin Cancers)
If you have a change on your skin, your doctor must find out whether or not
the problem is from cancer. You may need to see a dermatologist, a doctor
who has special training in the diagnosis and treatment of skin problems.
The dermatologist will check the skin all over your body to see if other
unusual growths are present.
If your doctor suspects that a spot on the skin is cancer, you may need a
biopsy. For a biopsy, your doctor may remove all or part of the skin that
does not look normal. The sample then goes to a lab. A pathologist checks
the sample under a microscope, looking for changes in the skin tissue cells.
Sometimes it’s helpful for more than one pathologist to check the tissue for
cancer cells. You may have the biopsy in a doctor’s office or as an outpatient
in a clinic or hospital. You will probably have a local anesthetic before the
biopsy is taken. (Source: NCI)
9
Diagnosing Melanoma (and other Skin Cancers), continued
Staging is a critical step in
determining your future plan of
care.
There are four common types of skin biopsies:
• Shave biopsy: The doctor uses a thin, sharp blade to shave off the
abnormal growth
• Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of
tissue from the abnormal area
• Incisional biopsy: The doctor uses a scalpel to remove part of the growth
• Excisional biopsy: The doctor uses a scalpel to remove the entire growth
and some tissue around it; this type of biopsy is most commonly used for
growths that appear to be melanoma
Staging Melanoma
If the biopsy shows that the skin change is melanoma (or any other cancer),
then further testing may be required to determine the “stage” of this
particular cancer. Staging is a critical step in determining your future plan
of care. To assign a stage to your melanoma, your doctor will:
• Determine the thickness. The thickness of a melanoma is determined by
carefully examining the melanoma under a microscope and measuring it
with a special tool called a micrometer. The thickness of a melanoma helps
doctors decide on a treatment plan. In general, the thicker the tumor, the
more serious the disease. (Mayo Clinic)
• See if the melanoma has spread. To determine whether your melanoma
has spread to nearby lymph nodes, your surgeon may use a procedure
known as a sentinel node biopsy. During a sentinel node biopsy, a dye is
injected in the area where your melanoma was removed. The dye flows
to the nearby lymph nodes. The first lymph nodes to take up the dye are
removed and tested for cancer cells. If these first lymph nodes (sentinel
lymph nodes) are cancer-free, there’s a good chance that the melanoma
has not spread beyond the area where it was first discovered. Cancer can
still recur or spread, even if the sentinel lymph nodes are free of cancer.
(Mayo Clinic)
• Order a more comprehensive work up if there is any evidence that the
melanoma has spread. This may include a number of diagnostic scans,
depending on the location of the melanoma, and other factors. Your doctor
may recommend a CT scan, an MRI, and/or a PET scan to help determine
if and where there might be additional melanoma cell clusters.
10
Melanoma is staged using the Roman numerals I through IV. A stage I
melanoma is small and has a very successful treatment rate. But the higher
the numeral, the lower the chances of a full recovery. By stage IV, the cancer
has spread beyond your skin to other organs, such as your lungs or liver.
These are the primary stages of melanoma (Source NCI):
Several factors may go
• Stage 0: The melanoma involves only the top layer of skin. It is called
melanoma in situ.
aggressiveness of a melanoma
• Stage I: The tumor is no more than 1 millimeter thick (about the width
of the tip of a sharpened pencil.) The surface may appear broken down.
Or, the tumor is between 1 and 2 millimeters thick, and the surface is not
broken down.
into determining the stage
(and guide the treatment
recommended). Specifically,
the pathologist evaluates the
by evaluating the cell patterns
and apparent rate of growth
(cell division).
• Stage II: The tumor is between 1 and 2 millimeters thick, and the surface
appears broken down. Or, the thickness of the tumor is more than 2
millimeters, and the surface may appear broken down.
• Stage III: The melanoma cells have spread to at least one nearby lymph
node. Or, the melanoma cells have spread from the original tumor to
tissues nearby.
• Stage IV: Cancer cells have spread to the lung or other organs, skin areas,
or lymph nodes far away from the original growth. Melanoma commonly
spreads to other parts of the skin, tissue under the skin, lymph nodes, and
lungs. It can also spread to the liver, brain, bones, and other organs.
Stage of Melanoma of the Skin When Diagnosed
Comparison of National, Dignity Health of the Central Coast Oncology Services (DHCCOS)
Findings [National=Data from Comprehensive Hospital in All States]
Stage #
National
Totals
National Percent
of all Melanomas
DHCCOS
Totals
DHCCOS
Percent
03,548
22.06%521.74%
I
6,68041.53%
6
26.09%
II
2,23413.89%
7
30.43%
III
1,233 7.67%
1 4.35%
IV 905 5.63%
3
13.04%
N/A 1 0.01%
Unknown 1,484 9.23%
1 4.35%
Total 16,085100.00%
Source: NCD Benchmark Reports, NCI & SEER Data 2012
23
100.00%
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Treatment Options for Melonoma Patients
The best treatment for any skin
cancer, including melanoma,
depends on the stage of
your cancer and your age,
overall health and personal
preferences. In most cases,
the goal of treatment is to
remove or destroy the cancer
completely. Most skin cancers
can be cured if found and
treated early.
(Sources: Mayo Clinic, NCI, ACS)
Treating early-stage melanomas: Treatment for early-stage melanomas
usually includes surgery to remove the melanoma. A very thin melanoma
may be removed entirely during the biopsy and require no further treat­
ment. If there are any melanoma cells seen at the edges (border) of the
biopsy, then your surgeon will remove the cancer as well as a small border
of normal skin and a layer of tissue beneath the skin. For people with earlystage melanomas, this may be the only treatment needed.
Treating melanomas that have spread beyond the skin: Your doctors
will discuss a variety of options and choices available to you, if you need
treatment beyond the initial surgery. You may have a team of specialists
to help plan your treatment. Your doctor may refer you to a specialist,
or you may ask for a referral. Specialists who treat skin cancer include
dermatologists and surgeons. Some people may also need a reconstructive
or plastic surgeon. People with advanced skin cancer may be referred to
a medical oncologist or radiation oncologist. Your health care team may
also include an oncology nurse, a social worker, and a registered dietitian.
Because skin cancer treatment may damage healthy cells and tissues,
unwanted side effects sometimes occur. Side effects depend mainly on the
type, location, and extent of the treatments and are unique for each person.
Before treatment starts, your health care team will tell you about possible
side effects and suggest ways to help you manage them.
Recent years of research have opened up new hope for patients that have a
melanoma that has spread beyond the skin. Treatment options may include:
• Surgery to remove affected lymph nodes. If melanoma has spread
to nearby lymph nodes, your surgeon may remove the affected nodes.
Additional treatments before or after surgery may also be recommended.
• Chemotherapy. Chemotherapy uses drugs to destroy cancer cells.
Chemotherapy can be given intravenously, in pill form or both so that it
travels throughout your body.
• Radiation therapy. This treatment uses high-powered energy beams,
such as X-rays, to kill cancer cells. It’s sometimes used to help relieve
symptoms of melanoma that has spread to another organ. Fatigue is a
common side effect of radiation therapy, but your energy usually returns
once the treatment is complete.
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• Biological therapy. Biological therapy boosts your immune system to help
your body fight cancer. These treatments are made of substances produced
by the body or similar substances produced in a laboratory. Biological
therapies used to treat melanoma include interferon and interleukin-2. Side
effects of these treatments are similar to those of the flu, including chills,
fatigue, fever, headache and muscle aches. Ipilimumab (Yervoy) is another
drug that uses your immune system to fight melanoma. Ipilimumab is used
to treat advanced melanoma that has spread beyond its original location.
• Targeted therapy. Targeted therapy uses medications designed to target
specific vulnerabilities in cancer cells. Vemurafenib (Zelboraf) is a
targeted therapy approved to treat advanced melanoma that can’t be
treated with surgery or melanoma that has spread through the body.
Vemurafenib only treats melanoma that has a certain genetic mutation.
Cells from your melanoma can be tested to see whether this treatment
may be an option for you.
Experimental Melanoma Treatments
Clinical trials are studies of new treatments for melanoma. Doctors use
clinical trials to determine whether a treatment is safe and effective. People
who enroll in clinical trials have a chance to try evolving therapies, but
a cure isn’t guaranteed. And sometimes the potential side effects aren’t
known. Some melanoma treatments being studied in clinical trials include:
Supportive Care: Many skin
cancers can be removed
quickly and easily. But some
people may need supportive
care to control pain and other
symptoms, to relieve the side
effects of treatment, and
to help them cope with the
feelings that a diagnosis of
cancer can bring. Additionally,
some people need assistance
in finding or accessing the
care they need. These support
services are available, free
of charge to all patients here
on the Central Coast. Please
note the locations and contact
numbers listed on page 19.
• New combinations of treatments. Researchers are testing whether
combining treatments may increase the effectiveness of melanoma
treatment. For instance, different combinations of chemotherapy,
biological therapy, targeted therapy and radiation have been proposed.
However, combining treatments can make severe side effects more likely.
• New targeted therapies. Researchers are testing new targeted medica­
tions in people with advanced melanoma. For instance, targeted drugs
designed to stop melanoma from attracting blood vessels have shown
some success. Blood vessels carry nutrients to the melanoma, and blood
vessels help spread cancer cells throughout the body. A drug that stops this
process could cause a melanoma to remain small and localized.
• Vaccine treatment. Vaccines for treating cancer are different from
vaccines used to prevent diseases. Vaccine treatment for melanoma might
involve injecting altered cancer cells into the body to draw the attention of
the immune system and hopefully stimulate it to develop defensive cells.
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Prevention and Early Diagnosis is Vital
We now realize how critical it
is to protect our skin from the
day we are born! Keep in mind
that knowing what you should
do to prevent skin cancers is
not enough. You must actually
follow through on the actions
recommended to decrease the
risk of developing skin cancer.
As noted throughout this report, there is an enormous survival advantage
for those that are able to be diagnosed earlier with melanoma (before it
has spread to other areas). An even greater advantage would be if we could
prevent the melanoma (or other skin cancers) from developing in the first
place. This is why (1) Prevention and (2) Early Diagnosis is what we shout
within the cancer care community! Since we believe that the majority of
UV radiation that contributes to skin cancer starts years before the visible
evidence of the skin damage/cancer shows up, we now realize how critical
it is to protect our skin from the day we are born. Here are a few proactive
steps each of us can take in our daily life to reduce our personal risk.
Preventive Measures
• Avoid midday sun. Avoid the sun when its rays are the strongest. For most
places, this is between about 10:00 a.m. and 4:00 p.m. Because the sun’s
rays are strongest during this period, try to schedule outdoor activities for
other times of the day, even in winter or when the sky is cloudy. You absorb
UV radiation year-round, and clouds offer little protection from damaging
rays. Seek the shade when you can.
• Protect yourself from “reflected” sun. UV light is reflected by sand,
water, snow, ice, and pavement. The sun’s rays can go through light
clothing, windshields, windows, and clouds.
• Wear sunscreen year-round, every day. Use a broad-spectrum (UVA and
UVB) sunscreen with a sun protection factor (SPF) of at least 15. (Some
doctors will suggest using a lotion with an SPF of at least 30). For extended
outdoor activity, use a water-resistant, broad spectrum product with an
SPF of 30 or higher. Apply sunscreen generously, and reapply every two
hours—or more often if you’re swimming or perspiring. Use a generous
amount of sunscreen on all exposed skin, including your lips, the tips of
your ears, and the backs of your hands and neck.
• Wear protective clothing. Sunscreens don’t provide complete protection
from UV rays, so wear tightly woven clothing that covers your arms and
legs and a broad-brimmed hat, which provides more protection than a
baseball cap or visor does. Some companies also sell photoprotective
clothing; your dermatologist can recommend an appropriate brand.
• Don’t forget sunglasses. Look for those that block both types of UV
radiation—UVA and UVB rays.
14
You can still enjoy the outdoors
while using sun safety at the
same time.
• Avoid tanning beds. Tanning beds emit UV radiation, which can increase
the risk of skin cancer.
• Keep newborns out of the sun. Sunscreens should be used on babies over
the age of six months.
• Become familiar with your skin so you’ll notice changes. Examine your
skin monthly, so that you become familiar with what your skin normally
looks like. This way, you may be more likely to notice any skin changes.
With the help of mirrors, check your face, neck, ears and scalp. Examine
your chest and trunk and the tops and undersides of your arms and hands.
Examine both the front and back of your legs and your feet, including the
soles and the spaces between your toes. Also check your genital area and
between your buttocks. If you notice anything unusual, point it out to your
doctor at your next appointment.
Sources: Mayo Clinic, NCI, and Skin Cancer Foundation (See References)
PHOTO BY CHRIS BURKARD
15
Teen Tanners: The New Faces of Melanoma
Women ages 18 to 39 are now
Limit the Sun, Not the Fun!
eight times more likely to be
If there’s any good news about melanoma, it’s this: You have the power to
substantially lower your risk of getting it. All it will cost you is a little extra
time spent protecting yourself from the sun and paying attention to the
moles on your skin. Developing protective habits as children and teens can
be life-saving in later years. All skin types (fair, medium and dark skin)
and people of all ages need protection from UVA and UVB rays. Everyone
should protect their skin: use sunscreen properly, wear a hat, cover up!
(Please see pages 16-17 for more suggestions.)
diagnosed with this potentially
deadly skin cancer than they
were just 40 years ago.
The Dangers of UV Indoor Tanning Beds
While it’s no secret that the number of people developing melanoma has
long been climbing, one group has had a disproportionately meteoric rise.
Women ages 18 to 39 are now eight times more likely to be diagnosed with
this potentially deadly skin cancer than they were just 40 years ago. This
is significant because the years of potential life lost due to melanoma are
higher than for other cancers. An American dying from melanoma loses
about 20 years of life.
This rise in skin cancer rates happens to coincide with the growth of indoor
tanning. Young women are by far the most frequent users of tanning
machines: 71 percent of tanning salon patrons are girls and women aged
16-29. However, people who tan indoors are 74 percent more likely to
develop melanoma, 2.5 times more likely to develop s­ quamous cell
carcinoma, and 1.5 times more likely to develop basal cell carcinoma
than non-tanners.
16
Melanoma is a potentially deadly form
of skin cancer
that is on the rise in teens.
One blistering sunburn in
childhood more than doubles a
person’s chances of developing
the deadliest form of skin
cancer later in life.
SCARY FACT #1
San Luis Obispo County has the highest rate of
new melanoma diagnoses in the state:
106 percent above the national average.
SCARY FACT #2
Ninety percent of childhood melanoma cases occur in
girls aged 10-19, and in those cases 40 percent of the time
the diagnoses and treatment are delayed.
SCARY FACT #3
About two Californians die of melanoma each day, for a total
of more than 800 deaths from melanoma every day.
SCARY FACT #4
Indoor ultraviolet (UV) tanners are 74 percent more likely to
develop melanoma than those who have not tanned.
Did you know? Due to the harmful effects of tanning beds,
California has banned the use of UV indoor tanning beds
for all minors under 18.
PHOTO BY CHRIS BURKARD
17
Questions to Ask Your Doctor Before Treatment
Good communication with
What is the stage of the disease?
your health care professional
Has the cancer spread?
Do any lymph nodes or other organs show signs of cancer?
is critical. Come to each
appointment prepared with
your questions and write down
the answers so you can review
them later.
What are my treatment choices? Which do you suggest for me? Why?
Is this something that can be treated locally, or should I seek care from a
university setting, in a major city?
What are the expected benefits of each kind of treatment?
What can I do to prepare for treatment?
Will I need to stay in the hospital? If so, for how long?
What are the risks and possible side effects of each treatment?
How can side effects be managed?
Will there be a scar? Will I need a skin graft or plastic surgery?
What is the treatment likely to cost? Will my insurance cover it?
How will treatment affect my normal activities?
Would a research study (clinical trial) be a good choice for me?
How often should I have checkups?
PLEASE NOTE:
References Used in This Report
The following programs/tutorials
on melanoma are available
at these sites in English or
Spanish:
American Cancer Society. Cancer Facts and Figures 2012. Atlanta: American Cancer
Society, 2012. Pg 21-22; Pg 32. http://www.cancer.org/acs/groups/content/@
epidemiologysurveilance/documents/document/acspc-031941.pdf.
Accessed Dec 6, 2012.
http://www.nlm.nih.gov/medline
plus/tutorials/melanoma/htm/
index.htm
http://www.nlm.nih.gov/medline
plus/spanish/tutorials/melanoma
spanish/htm/index.htm
18
Primary Source: Mayo Clinic
Mayo Clinic Web Site. http://www.mayoclinic.com/health/skin-cancer.
Accessed Dec 6, 2012.
Mayo Clinic Web Site. http://www.mayoclinic.com/health/melanoma.
Accessed Dec 6, 2012.
National Cancer Institute Web Site. What You Need To Know About Melanoma and
Other Skin Cancers. http://www.cancer.gov/cancertopics/wyntk/skin.
Accessed Dec 6, 2012.
National Cancer Institute Surveillance Epidemiology and End Results Web Site.
http://seer.cancer.gov/statfacts/html/melan.html. Accessed Dec 7, 2012.
Skin Cancer Foundation Web Site. http://www.skincancer.org/prevention.
Accessed Dec 6, 2012.
Turn to Us for Answers About Cancer
Dignity Health is committed to helping people stay well by making healthy
lifestyle choices. If you have concerns, please call us!
Dignity Health Central Coast
Marian Regional Medical Center at Mission Hope Cancer Center
cancer services regional
Director
1325 East Church Street, Suite 102, Santa Maria, CA 93454
805.219.HOPE (4673) • Se habla español: 805.346.3406
www.missionhopecancercenter.com
Jenni Davis
Sean Hunt, RN, BSN, OCN
Oncology Counselor and
Patient Advocate
Cancer Care Navigator/
Survivorship Program
346.3402
346.3401
[email protected]
[email protected]
Liz Elliott, RN, OCN, CBCN,
CBPN-IC
Michelle Lamarche, RN
Breast Care Navigator
346.3405
[email protected]
Alison Fernandez, RN, MPH,
OCN
UCLA Clinical Research Coordinator
[email protected]
Tina McEvoy, RN, BSN,
CHPN
Hospice and Palliative Care
Director
739.3828
[email protected]
346.3421
[email protected]
Chris Magana
cancer center transport coordinator
346.3444
[email protected]
[email protected]
John Malinowski
Carol Herrin, RN, OCN
cancer exercise trainer
346.3463
346.3434
assistant nurse manager
mission hope infusion center
346.3461
Clinical Research Navigator
Katherine M. Guthrie
346.3413
[email protected]
[email protected]
Arroyo Grande Community Hospital
Coastal Cancer Care Center
French Hospital Medical Center
Hearst Cancer Resource Center
921 Oak Park Boulevard, Suite 100B
Pismo Beach, CA 93449
www.arroyograndehospital.org
1941 Johnson Avenue, Suite 201A
San Luis Obispo, CA 93401
www.frenchmedicalcenter.org
Mary Fedel, RN, OCN
Gloria Caine, RN, BSN, OCN,
CBPN-C
Cancer Care Navigator
481.7245
[email protected]
Infusion Center of San Luis Obispo
715 Tank Farm Road, Suite B
San Luis Obispo, CA 93401
Susan L. Diaz, RN, OCN
clinical supervisor
Nurse Navigator, HCRC
542.6234
m e dic a l di r e c t o r s
marian regional
medical center
Robert A. Dichmann, M.D.
Arroyo Grande
Community Hospital
Edwin Hayashi, M.D.,
F.A.C.S.
[email protected]
French Hospital
medical center
Beverly Kirkhart
Thomas Spillane, M.D.
Director, HCRC
542.6269
[email protected]
786.6144
[email protected]
19
1325 East Church Street, Suite 102
Santa Maria, CA 93454
D I G N I T Y H EALT H o f t h e C E N TRAL C OAST
Marian Regional Medical Center
Marian Cancer Care
www.marianmedicalcenter.org/mariancancercare
Email: [email protected]
1325 East Church Street, Santa Maria
805.219.HOPE (4673)

Commission on Cancer
Comprehensive Community Cancer Program
Arroyo Grande Community Hospital
Coastal Cancer Care Center
www.arroyograndehospital.org
921 Oak Park Blvd., Suite 100B, Pismo Beach
805.481.7245

Commission on Cancer
Community Cancer Program
French Hospital Medical Center
Hearst Cancer Resource Center
www.frenchmedicalcenter.org
1941 Johnson Avenue, Suite 201A, San Luis Obispo
805.542.6234
20
HEARST CANCER
RESOURCE CENTER

cover PHOTO BY CHRIS BURKARD